Best practice in the treatment of chronic hepatitis B: A summary of the European Viral Hepatitis Educational Initiative (EVHEI)

Hepatitis B causes acute and chronic hepatitis, the latter resulting in cirrhosis and hepatocellular carcinoma. There are four phases of infection: during the phases of immune tolerance and immune control of the virus, no treatment is recommended but in the phases of immune clearance and immune escape, viraemia with biopsy evidence of significant fibrosis requires anti-viral therapy. The areas of agreement and disagreement between the various consensus statements are discussed. Health economic issues indicate that a trial of pegylated interferon should be offered in non-cirrhotic cases, particularly those that are HBe antigen positive, followed in those that do not establish a sustained viral response, by long term viral suppressive therapy with nucleoside analogues singly or in combination. The indications for treatment and methods of follow-up, as well as issues of viral resistance are discussed.